Antenatal - Multiple pregnancies Flashcards

1
Q

multiple pregnancy:

define monozygotic

A

identical twins - from a single zygote

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2
Q

multiple pregnancy:
define dizygotic

A

non-identical (from 2 different zygotes)

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3
Q

risk factors for dizygotic twins

A
  • super ovulater - FHx
  • IVF
  • PMHx
  • nigerian
  • clomifene
  • age
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4
Q

multiple pregnancy:

define monoamniotic

A

single amniotic sac

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5
Q

multiple pregnancy:

define diamniotic

A

2 separate amniotic sacs

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6
Q

multiple pregnancy:

define monochrionic

A

share a single placenta

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7
Q

multiple pregnancy:

define dichorionic

A

2 separate placentas

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8
Q

which twin pregnancies have the best outcome and why?

A

diamniotic dichorionic as each fetus has their own nutrient supply

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9
Q

when are multiple pregnancies usually diagnosed?

A

booking ultrasound

10 - 13+6

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10
Q

what is seen on ultrasound scan for dichorionic diamniotic twins?

A

have a membrane between the twins with a lambda sign or twin peak sign. this is the triangular appearance where the membrane between the twins meets the chorion as the chorion blends partially with the membrane

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11
Q

what is seen on ultrasound scan of monochorionic diamniotic twins

A

have a membrane between the twins with a T sign. the T sign refers to where the membrane between the twins abruptly meets the chorion giving the T appearance

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12
Q

what is seen on ultrasound of monochorionic monoamniotic twins?

A

no membrane separating the twins

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13
Q

what are some risks to the mother of multiple pregnancies?

A
  • Anaemia
  • Polyhydramnios
  • Hypertension
  • Malpresentation
  • Spontaneous preterm birth
  • Instrumental delivery or caesarean
  • Postpartum haemorrhage
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14
Q

what are some risks to the fetus and neonates of multiple pregnancies

A
  • Miscarriage
  • Stillbirth
  • Fetal growth restriction
  • Prematurity
  • Twin-twin transfusion syndrome
  • Twin anaemia polycythaemia sequence
  • Congenital abnormalities
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15
Q

What is Twin-Twin Transfusion Syndrome?

A

occurs when the fetuses share a placenta. where there is a connection betwen the. blood supplies of the 2 fetuses, 1 may receive the majority of the blood (recipient) from the placenta while the other is starved of blood (donor).

the recipient gets the majority of the blood and can become fluid overloaded with heart failure and polyhydramnios

the donor has growth restriction, anaemia and oligohydramnios

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16
Q

how is twin-twin transfusion syndrome managed?

A

referred to a tertiary specialist fetal medicine centre

laser treatment may be used to destroy the connection between the 2 blood supplies

17
Q

what is twin anaemia polycythaemia sequence?

A

like twin-twin transfusion syndrome but less acute

one twin becomes anaemic whilst the other develops polycythaemia

18
Q

what additional antenatal care is needed in multiple pregnancies?

A

FBC monitoring for anaemia at booking clinic, 20 wks and 28 wks

additional ultrasound scans to monitor fro FGR, unequal growth, TTTS - 2 weekly from 16 weeks in monochorionic twins and 4 weekly from 20 weeks for dichorionic twins

19
Q

when are births planned for uncomplicated monochorionic monoamniotic twins, monochorionic diamniotic twins, dichorionic diamniotic twins and triplets?

A

increased risk of fetal death beyond these dates

corticosteroids given before delivery to help mature lungs

20
Q

delivery options for twins

A
21
Q

delivery things for twins

A

continuous CTG of both babies

uss before - lie and fetal heart rate

epidural for vaginal

oxytocin use liberally

if 2nd not cephalic - ecv, icv or c section for 2nd baby

active management of 3rd stage